【摘要】 目的通过浅谈1例支气管Dieulafoy病大咯血救治过程的体会,总结复习支气管Dieulafoy病及内镜检查大咯血的救治。方法回顾分析一例内镜检查过程中出现大咯血患者的救治过程,结合文献复习,探讨支气管Dieulafoy病的救治方法。结果支气管扩张患者的支气管镜结果,支气管镜提示:左固有上叶前段开口粘膜异常,进行活检,出血约50mL,予常规镜下止血后,出血停止。但术后当日、术后第7天、术后第14天反复发生大咯血,内科保守治疗+血管介入栓塞术,无好转。患者血色素急剧下降,氧饱和度不能维持,紧急进行气管插管,提示鲜红色血栓堵塞左主支气管,镜下仍见渗血,胸外科进行左上叶切除术,术后病理提示为"肺结核"。结合患者病史及气管镜下粘膜表现以及支气管动脉造影,考虑患者为支气管Dieulafoy病。结论支气管Dieulafoy病一旦活检出现咯血,致死率极高,常规镜下止血、球囊扩张压迫止血、血管介入等方法无效时,及时果断的进行出血目标肺段切除,有助于抢救患者,改善预后。更多还原

【Abstract】 Objective To summarize and review the treatment of bronchial Dieulafoy’s disease and massive hemoptysis by endoscopy.Methods The treatment process of a patient with massive hemoptysis during endoscopic examination was retrospectively analyzed. Combined with literature review, the treatment methods of bronchial Dieulafoy disease were discussed. Results In patients with bronchiectasis, bronchoscopy showed that the mucosa of the anterior segment of the left superior proper lobe was abnormal. Biopsy was performed, and the bleeding was about 50 mL. after routine hemostasis, the bleeding stopped. However, massive hemoptysis occurred again and again on the day after operation, 7 days after operation and 14 days after operation. The patient’s hemoglobin decreased sharply, and oxygen saturation could not be maintained. A rapid endotracheal intubation indicated that the left main bronchus was blocked by bright red thrombus. Under the microscope, blood still seeped. Thoracic surgery was asked to perform left upper lobe resection. Postoperative pathology showed "pulmonary tuberculosis". Combined with the history of the patient, the mucosal manifestations under bronchoscopy and bronchial arteriography, the patient was considered as bronchial Dieulafoy disease. Conclusion Once hemoptysis occurs in bronchial Dieulafoy disease biopsy, the mortality rate is very high. When routine hemostasis, balloon dilatation and compression hemostasis, vascular intervention and other methods are ineffective, timely and decisive resection of the bleeding target lung segment is helpful to rescue patients and improve the prognosis.更多还原